Zimbabwe dials 90-90-90

Alois Vinga Correspondent Zimbabwe has had a fair share of the HIV/Aids challenge in the last 30 years but has notched key successes, among them reduction of infection rates and the roll-out of anti-retroviral medicines. This has been achieved through Government and its partners’ efforts and conformity to world standards and trends. Now, Zimbabwe is going 90-90-90. The global 90-90-90 campaign was enunciated at the UNAIDS International Aids Conference in Melbourne, Australia, last August, referring to three key steps that are essential to both better health and care for HIV-positive people and to limiting new infections and the further spread of the HIV pandemic.

Speaking at the International Aids Conference feedback meeting in Harare last week, Mr David Mutambara explained: “The 90-90-90 is an adoption of the International Aids Conference thereby a new world strategy that will eradicate AIDS by 2030.

“The philosophy is that across the world’s nations, 90 percent of people must get tested; 90 percent of people living with HIV should be on treatment; and 90 percent of people on treatment should have suppressed viral loads.”

The latter point relates to the importance of wider access to viral load monitoring and the importance of viral suppression as a major goal of anti-retroviral therapy and also recognises the dramatic reduction in transmission risk once viral load is undetectable.

Mr Mutambara said: “90-90-90 is not just a numeric target. It is a moral and economic necessity. It will keep people living with HIV alive and healthy, protect future generations from infection, provide economic value over the long term and drive the AIDS epidemic into history.

“Globally, resources for fighting the pandemic are dwindling hence the need to focus on local resources by changing the mentality we have as a nation. “While most of the people see finance as an imperative factor, there is also the need to view time and human resources as equally important and focus on effective use. This will see the proper evaluation of projects that have since been initiated, thereby avoiding semi accomplished work.”

He noted that generalisation of the epidemic in Zimbabwe was detrimental to the Aids response hence the need to thoroughly assess how much of 13 million people in Zimbabwe are being covered and the exact impact that has been made on the 1,4 million patients by the current programmes.

He further noted that in terms of research, most of findings had been anecdotal, thereby only addressed the symptoms of the virus. There is now the need, he said, to tackle the root causes of the symptoms by identifying key drivers and undertaking studies and surveys in order to achieve the 90-90-90 paradigm. Officials say eradicating AIDS by 2030 in Zimbabwe will entail coming up with strategies that deal with incorporating children living with AIDS.

Statistics released at the International Aids Council feedback meeting hosted by the National Aids Council and the Ministry of Health and Child Care confirm that out of the 170 000 children living with HIV, 45 percent are receiving treatment.

Focusing on children Sara Page-Mtongwiza, director of programmes at Families and Communities for the Elimination of Padiatric HIV (FACE) led by the Organisation for Public Health Interventions and Development, notes that in Zimbabwe, HIV is one of the major contributors to childhood morbidity and mortality estimated at 9 percent . “However, the number of HIV-positive children who are then initiated on treatment remains disappointingly low,” she bemoaned.

The national paediatric ART coverage was estimated to be 44 percent but as of December, 2013, however, in some districts paediatric ART coverage has been reported to be as low as 10 percent.

Page-Mtongwiza said: “At the start of the FACE-Peadiatric HIV programme (2012), the coverage of paediatric HIV care and treatment services was very limited, as health care workers reported that they were not confident to treat children. However, the recent roll-out of Option B+ (life-long ART for pregnant and lactating women) has been an opportunity to decentralise and strengthen paediatric HIV care and treatment services.

With technical support from partners, the MOHCC has managed to approve more sites to offer paediatric HIV care and treatment services. A strong push has been made to provide clinical mentorship to health care workers to ensure that they have the capacity and confidence to treat infants and children living with HIV.” However, the challenge of finding and identifying infants and children living with HIV remains significant.

Authorities say the Prevention of Mother To Child Transmission programme has been very successful, but after the delivery of the baby, the mother-HIV-exposed baby is often lost-to-follow-up, meaning that they do not return to have the child tested (or to receive the results of the child’s test).

Many HIV-positive children return to the health system only when they are ill, but then they are treated for malnutrition, or other health problems, and they are not offered an HIV-test (despite the national policy for provider-initiated testing and counselling).

There is need for concerted effort between health care workers, community leaders, parents and guardians to make sure that children are tested for HIV, and those that are positive are initiated on treatment as soon as possible.

Doctor Wade Ndebele, who represented the paediatrics at the International Aids Conference, said fighting HIV in children was complicated due to limited availability of paediatric formulations and difficulties in harmonising regimens with adults while poor retention of children on ART also militated against the efforts.